Still El Paso Strong
Drs. Alan Tyroch and Susan McLean
Lessons from Aug. 3 Mass Shooting on Tragedy’s Fifth Anniversary
The Aug. 3, 2019, mass shooting at an El Paso Walmart provided invaluable lessons for Texas Tech Health El Paso faculty who are teaching students to respond to mass casualty incidents.
The only Level 1 trauma center within a 280-mile radius, University Medical Center of El Paso received 14 gunshot wound victims that Saturday.
UMC is also the academic medical hospital of Texas Tech Health El Paso. An academic medical hospital is a health care facility closely affiliated with a medical university, such as Texas Tech Health El Paso. In this setting, medical students, residents, fellows and nursing students receive hands-on training and education while providing patient care.
On Aug. 3, our trauma and surgery doctors treated and received these patients, sat with families during these uncertain times.
Twenty-three people were killed and 22 wounded in the mass shooting. Del Sol Medical Center, which was close to the shooting, also treated victims. In addition to Texas Tech Physicians of El Paso treating patients that day, Texas Tech Health El Paso physician residents and Hunt School of Nursing students also assisted.
"The hospital definitely functioned as a large trauma team,” said Susan McLean, M.D., FACS, surgeon and director of surgical critical care at UMC, and professor in the Department of Surgery at Texas Tech Health El Paso. “I did a survey on 12 departments of both the hospital and the physicians, and I found that 132 of our team came into the hospital that day on short or no notice and worked. They immediately came in to take care of these patients.”
Although all Texas Tech Health El Paso faculty pray it never happens, they regularly train students and staff for the worst-case scenario. That preparation was key to providing life-saving care for the patients on Aug. 3.
“We continuously train our students and staff for mass injuries and casualties,” Dr. McLean said. “We had an exercise about eight months before this tragedy. We just had a drill in this past year on a mass casualty event. Every time, we go over what we can do to improve."
Alan Tyroch, M.D., FACS, FCCM, professor and chair of surgery at Texas Tech Health El Paso’s Foster School of Medicine and surgery chair for Texas Tech Physicians of El Paso, echoed those sentiments. Dr. Tyroch is also chief of surgery and trauma medical director at UMC.
“The Joint Commission requires health care facilities to conduct two disaster drills each year,” Dr. Tyroch said. "And if you don't practice, you're not going to be ready the day the event occurs.”
The Joint Commission is a national safety and quality accrediting body for health care organizations.
Approximately every 18 months, the Department of Emergency Medicine at Texas Tech Health El Paso conducts large-scale disaster drills as part of its three-year training program for emergency medicine residents. The department’s disaster drill in 2017 was based on an active-shooter scenario.
The drills typically bring together a wide range of participants, including residents training in other specialties, Texas Tech Health El Paso medical and nursing students, personnel from the El Paso Fire Department and first-responder trainees from our community. Middle and high school students from area schools have also participated in the drills, sometimes role-playing as simulated patients or training as part of their high schools’ first-responder programs.
Dr. Tyroch emphasized it’s not if a disaster occurs, but when.
"We all face that. Every community will be facing that because, unfortunately, we’re seeing more and more of these events,” Dr. Tyroch said. “So, we need to be ready.”
As the fifth-year anniversary approaches, Dr. McLean still remembers the survivors and their families. She's inspired by their resiliency.
“Every single one of them was determined to improve and get out of the hospital. None of them sat around and felt sorry for themselves,” Dr. McLean said. “They got up and worked with physical therapy even when they were in pain. I remember at least one of them had a loved one in another hospital, but they got up and said, ‘we're going to get better.’ They're the most determined group of patients as a group I've ever treated. They were inspiring to have risen up despite this tragedy and despite what was likely the worst day of their lives."
Passing Lessons Along to Others
Texas Tech Health El Paso faculty have addressed the mass shooting several times over the five years, from testifying before legislative bodies to presenting at health care conferences.
"There were numerous lessons learned from the shooting and from reviewing it,” Dr. McLean said. “We learned how to make extra space in your hospital to accommodate a mass casualty event and how to expand your personnel teams rapidly. A third was the importance of having family meeting centers so our community could have a place to go and receive information.”
With regard to treatment, Dr. McLean said the hospital is continually improving the trauma program, including having monthly meetings to review and improve the quality of trauma care.
Also important for mass casualty response is patient blood management for transfusions. Dr. Tyroch said it’s becoming standard for patients to receive whole blood prior to arriving at the hospital. As its name implies, whole blood transfusions involve treating the patient with all the components of blood, rather than separate components of red cells, plasma and platelets.
“It was shown in Afghanistan and Iraq that if you could just donate the whole blood, it has an important resuscitation capability,” Dr. Tyroch said. “So, now at UMC, we use whole blood. We get 15 units a week, and we use a lot of it.”
Dr. Tyroch sits on the Texas governor’s EMS Council and put together a task force to develop protocols for ambulances to carry whole blood so EMS teams can administer life-saving transfusions to trauma victims.
“Our goal is to bring prehospital blood across the state,” Dr. Tyroch said. “A good example is Uvalde in 2022. San Antonio put blood on a helicopter and flew it out to them about 100-plus miles away. If, heaven forbid, there is another terrible casualty event here or any other place in Texas, we can have places like San Antonio fly the blood to us on a jet, and we can disperse it.”
Medical personnel who helped out on Aug. 3 have also developed recommendations for responding to disasters and mass shootings. In Jan. 2020, Dr. Tyroch presented the Texas Medical Association’s eight recommendations for addressing mass violence to a special committee of the Texas House of Representatives.
"We shared what we learned with our community the first December after the event when we presented at the Rio Grande Trauma Conference and Pediatric Update,” Dr. McLean said.
In 2022, Dr. McLean joined emergency medicine physician and assistant professor Nancy Weber, D.O., M.B.A., FACOEP, FACEP, and other clinicians who responded to six mass shootings. They convened under the auspices of the Uniformed Services University of the Health Sciences’ (USU) National Center for Disaster Medicine and Public Health to review responses to mass shootings. Their study, “Mass Shootings in America: Consensus Recommendations for Healthcare Response,” was published in the Journal of the American College of Surgeons. Their recommendations were:
Readiness training: Regular training activities that mirror the realism of actual events to ensure readiness of the entire community system.
Public education: Public education or immediate direction from web-based programs to teach the public about which hospitals are best equipped to care for mass shooting patients.
Triage: A staged and iterative triage process at the scene, and emergency department, and to prioritize operative care.
Communication: Effective communication between prehospital staff at the scene and hospitals.
Patent tracking: A patient tracking system that functions from point-of-injury through subsequent care.
Medical Records: Rehearsal with and rapid availability of alternative methods of patient care documentation and order entry.
Family reunification: Rapid implementation of organized, well-communicated family reunification and assistance services.
Mental health services: Tailored after-action mental health services for responding health care professionals.
Importance of Mental Health
Five years later, our community is still processing the trauma and stress endured that day, said Sarah Martin, M.D., an assistant professor and chief of the Department of Psychiatry’s Child and Adolescent Division at Texas Tech Health El Paso.
“The events of Aug. 3 brought us together in an unprecedented way; that likely helped us bounce back after the COVID-19 pandemic,” Dr. Martin said. “El Paso is a very special, close-knit community, and together we’ve become a stronger community. These two traumatic events were unique in that they brought mental health issues to the forefront, which has never happened before to this large extent.”
Emotional trauma can still be felt by those who were injured that day at the Cielo Vista Walmart, and it may still affect uninjured people who were working or shopping, as well as those on the front lines of the emergency response.
Anniversaries honoring victims of a traumatic event are important to most people, but the effect can vary from culture to culture, Dr. Martin said. For some people, gathering with family, friends and others on the anniversary date to honor a person who died can be therapeutic. But others may experience an increase in PTSD symptoms around that time.
The emotional healing journey “is an individualized process,” Dr. Martin said.
Even after five years, children may still need their parent’s help processing the Aug. 3 mass shooting.
“Sometimes when trying to protect children, we don’t tell them the entire story and they’re left to their imaginations,” Dr. Martin said. “Usually what they imagine is even worse than the actual event. If we don’t process trauma with our children, then we’re teaching them to pretend nothing is happening when very important things are happening.”
About Texas Tech Health El Paso
Texas Tech Health El Paso is the only health sciences center on the U.S.-Mexico border and serves 108 counties in West Texas that have been historically underserved. It’s a designated Title V Hispanic-Serving Institution, preparing the next generation of health care heroes, 48% of whom identify as Hispanic and are often first-generation students.
Established as an independent university in 2013, Texas Tech Health El Paso is a proudly diverse and uniquely innovative destination for education and research.
With a mission of eliminating health care barriers and creating life-changing educational opportunities for Borderplex residents, Texas Tech Health El Paso has graduated over 2,400 doctors, nurses and researchers over the past decade, and will add dentists to its alumni beginning in 2025. For more information, visit ttuhscepimpact.org.